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Now let's cover head, back, and neck injuries. We have a person here who looks like they took a fall down the stairs, there were no bystanders around who could give us an eye witness account of what happened exactly. We don't know if he hit his head, we don't know how many stairs he fell down. What we do know is he is laying down on the base of a set of stairs, there is a flight of stairs, and he appears to be in pain. So, what we're gonna do is try to minimize the movement of the patient as we begin to inquire more about what may have happened, and what's going on. Remember, the whole point of doing this is to figure out if we call 911 and get help on the way or whether this person is well enough to be able to get back into regular life, and just kinda walk it out. Maybe that could happen, we know that weird things have happened, and we mysteriously can escape without injury or harm, we don't know how, but it happens, and then other times, we have a true injury. So, this is kinda how it's gonna look. I am not going to touch the patient, and I am immediately going to say, Sir, I am Roy, and I can help. I've been trained. I'd like you not to nod your head, just answer me with yes or no or descriptions, and then try not to move any part of your body just in case you have broken bones or an injury okay. Speaker 2: Okay. Speaker 1: Alright, I am looking over your head, I don't see any bleeding, I am gonna check his ears and look for any blood coming out of either ear. I am looking in the mouth, can you smile a little bit, there is no broken teeth that I can see, there is no blood coming from the nose, as I look at his pupils, they seem to be equal and responsive to light. You can also do that by putting your hand over and then bring it back and see if the pupils react, and if they don't this could indicate that they have a concussion, some swelling in the brain, and that would be an immediate 911 call. Now, next, he is able to talk to me, which means he is breathing, and awake, and has a heartbeat, which means that there are none of those three reasons to call 911 immediately. So, I'm gonna ask him a couple of questions. Sir, do you remember what just happened? Speaker 2: I was, I was carrying some boxes down the stairs and I fell. Speaker 1: Okay, do you know if you hit your head? Speaker 2: I, I don't remember. I don't think so. Speaker 1: Do you know what day is it today? Speaker 2: It's Tuesday. Speaker 1: Okay, and it's actually Friday, and do you know like what year it is? Speaker 2: 2001 Speaker 1: And it's incorrect. So, those two incorrect questions might lead me to think that he did hit his head, he may have lost or may not have lost consciousness, it really doesn't matter, but then he maybe suffering some altered mental status, as a result of his fall. That's enough for me to say, you in the plaid shirt, go call 911, and come back. I might need your help and bring an AED if you can find one. Now, at the same time, I am gonna continue with open-ended questions, so now what does that mean? It means I'm not leading him to give me the answer I'm looking for, so I'm just gonna generally say can you tell me what hurts right now? Speaker 2: My neck and my back really hurts. Speaker 1: Okay, so bad that you feel like you can't move? Speaker 2: I can't move. Speaker 1: Okay, and are you unable to move your arms or you're just trying to help your back? Speaker 2: I can move them. Speaker 1: Can you wiggle your fingers then? Can you wiggle your toes? So, we're not seeing any paralysis per se, which would be another thing which might lead to spinal shock which would then get us thinking as a responder, they could get pale, cool, sweaty, go unresponsive, and we might need to do CPR, because of spinal cord injury. So, if we do see any signs of shock, we're gonna cover them with a sheet quarter blanket, and then we're going to continue to re-assess the patient for airway breathing or circulation problems. If at any time, they begin to show problems with unresponsiveness, they're not breathing normally, or they go into full cardiac arrest, we're gonna treat them accordingly, and wait for EMS to arrive.
If you come upon a patient who appears to have taken a fall, or was injured in an accident, and there are no bystanders around who witnessed the accident, you'll need to figure out the mechanism of injury. Hopefully the victim will be able to help, who in this lesson, we are assuming is conscious, alert, and not exhibiting more serious issues involving airway, breathing, circulation, etc.
The most important thing to keep in mind as you deal with someone who has sustained potential injuries to their head, neck, and/or back, is minimizing movement, as you inquire more into what happened and how the patient is feeling.
Pro Tip #1: Part of your job is to figure out if EMS is required as you tend to them. It may be a situation where the victim is able to get up and has no significant injuries. Or it could be a situation that doesn't appear serious initially, but suddenly becomes serious. If at any point the situation warrants it, call 911 immediately.
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim.
Are you OK? Can you hear me?
If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment. When dealing with potential back and neck injuries, it's best not to touch the patient while you assess them.
Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. I'm going to ask you some questions; try not to nod. Answer with yes or no. And try not to move other parts of your body."
"Do you remember what just happened?"
"Do you know if you hit your head?"
"Do you know what day it is?"
"Do you know what year it is?"
If the victim answers the last two questions incorrectly, you're likely dealing with someone who has hit their head and may have a concussion. This altered mental state is enough of a concern to call 911 and activate EMS if you haven't already done so.
The fact that you're able to talk with the patient is a good sign. It indicates that they're awake, breathing normally, and have a pulse, all of which indicate a lack of an immediate emergency. However, that doesn't mean the situation cannot suddenly change.
As you're talking with the victim, you're also looking them over for injuries, beginning with their head.
Pro Tip #2: Put your hand over the victim's eyes for a second or two then remove it and see if their pupils react. If they do not, it could be due to a concussion and swelling in the brain.
Determine how injured they are by seeing how much they can move and with open-ended questions.
"Can you tell me what hurts?"
"Can you wiggle your fingers?"
"Can you wiggle your toes?"
A victim in paralysis is prone to going into spinal shock. Remember, shock is a progressive condition in which the circulatory system fails to adequately circulate oxygenated blood to all parts of the body.
Early signs of shock to look for include:
Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.
Warning: Should you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call.
If at any point during your assessment, the patient goes unresponsive, appears to be having trouble breathing normally, or goes into full cardiac arrest, activate EMS and treat the patient accordingly until help arrives, an AED arrives, or the patient is responding positively.
Injuries to the neck and spine can damage soft tissue and bone, including the spinal cord. Unfortunately, assessing the level of this damage on the scene, and without proper diagnostic equipment, is very difficult. Which is why you should always proceed with caution.
Some common situations in which serious neck and spine injuries tend to be seen include:
Some common symptoms for serious neck injury are:
Some common symptoms for serious spine injury are: